Smoking After PCI | Journal Scan

Study Questions:

What is the impact of smoking cessation on health outcome of patients undergoing percutaneous coronary intervention (PCI)?


The authors used data from patients enrolled in the PRISM study and categorized 2,765 PCI patients into never smoked, past smokers (smoked in the past, but had quit before PCI), quitters (smoked at time of PCI, but then quit), and persistent smokers. Health status was measured with the disease-specific Seattle Angina Questionnaire and the EuroQol 5 dimensions, adjusted for baseline characteristics.


At baseline, active smokers had significantly lower health status scores than past and nonsmokers. One year after PCI, patients who never smoked and previously smoked had higher scores in all health-related quality of life (QOL) domains than patients who continued to smoke after PCI. Quitters had health status scores that were either similar to nonsmokers or intermediate between nonsmokers and persistent smokers. In fully adjusted analyses, persistent smokers showed significantly worse health-related QOL when compared with never smokers. Of those who smoked at the time of PCI, those who quit had significantly better adjusted Seattle Angina Questionnaire angina frequency scores (mean difference, 2.73; 95% confidence interval, 0.13–5.33) and trends toward higher disease-specific (Seattle Angina Questionnaire QOL mean difference, 1.97; 95% confidence interval, −1.24 to 5.18), and overall (EuroQol 5 dimension visual analog scale scores mean difference, 2.45; 95% confidence interval, −0.58 to 5.49) QOL when compared with persistent smokers at 12 months.


The authors concluded that among patients undergoing PCI, smokers who quit after PCI have less angina at 1 year than those who continue to smoke.


The deleterious impact of persistent smoking on outcome of patients undergoing PCI was recognized almost 2 decades ago (Hasdai, N Engl J Med 1997), and smoking cessation counseling is an integral component of post-PCI care. This study suggests that patients who continue to smoke after PCI have worse QOL, and provides another impetus to focus on smoking cessation in this population.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention, Smoking

Keywords: Angina Pectoris, Counseling, Health Status, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Quality of Life, Questionnaires, Smoking, Smoking Cessation, Visual Analog Scale

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